Prednisone, Lupus Activity, and Permanent Organ Damage
DENNIS COTTER and
Objective. To estimate the effect of corticosteroids (prednisone dose) on permanent organ damage among persons with systemic lupus erythematosus (SLE).
Methods. We identified 525 patients with incident SLE in the Hopkins Lupus Cohort. At each visit, clinical activity indices, laboratory data, and treatment were recorded. The study population was followed from the month after the first visit until June 29, 2006, or attainment of irreversible organ damage, death, loss to follow-up, or receipt of pulse methylprednisolone therapy. We estimated the effect of cumulative average dose of prednisone on organ damage using a marginal structural model to adjust for time-dependent confounding by indication due to SLE disease activity.
Results. Compared with non-prednisone use, the hazard ratio of organ damage for prednisone was 1.16 (95% CI 0.54, 2.50) for cumulative average doses > 0–180 mg/month, 1.50 (95% CI 0.58, 3.88) for > 180–360 mg/month, 1.64 (95% CI 0.58, 4.69) for > 360–540 mg/month, and 2.51 (95% CI 0.87, 7.27) for > 540 mg/month. In contrast, standard Cox regression models estimated higher hazard ratios at all dose levels.
Conclusion. Our results suggest that low doses of prednisone do not result in a substantially increased risk of irreversible organ damage.
Added Note: Low disease activity state (LLDAS) is associated with less long-term damage. Many specialists are convinced that true remission should be their ultimate treatment goal. For example, LLDAS allows up to 7.5 mg of prednisone daily, while it was shown that prednisone doses above 6 mg/day significantly increase the risk of later organ damage by 50%.